DIC + Sickle Cell Flashcards
What is ITP?
Idiopathic thrombocytopenia purpura
Low platelets causing purpuric rash
Autoimmune
Treat with steroids, immunoglobulins + platelets
What is DIC?
Disseminated intravascular coagulation
Clots formed in small vessels, using up platelets + clotting factors so bleeding occurs elsewhere (bleeding in skin, haematuria etc)
What scoring system is used for DIC?
ISTH
When should a platelet transfusion be given in DIC?
Pts bleeding or high risk of bleeding + platelet count <50
When is fresh frozen plasma given to pts with DIC?
Bleeding pts with DIC + prolonged PT + aPTT
When should heparin be given in DIC?
If thrombosis predominates:
VTE, purpura fulminans, ischemia, vascular skin infarction
Use continuous infusion of unfractionated heparin due to short half life + reversibility
Can be given as prophylaxis in non-bleeding pts against VTE
What should pts with DIC + sepsis be treated with?
Recombinant human activated protein C
Causes of DIC
Sepsis (gram negative) Trauma Obstetric complications Pancreatitis Malignancy Nephrotic syndrome Transfusion
(STOP Making New Thrombi)
S+S sickle cell disease
Recurrent haemolysis
Thrombosis in mesenteric, intracranial + bone = severe pain
Pathology of sickle cell
HbS inherited instead of HbA
Caused by mutations on B-globin gene
Distorts RBC in sickle shape which form clusters
Sickled cells have decreased lifespan, resulting in blood vessel occlusion + ischaemia, infections + pain in liver + spleen
Exacerbated by low O2 tension, dehydration + cold
Why will a newborn with sickle cell disease initially be asymptomatic?
The newborn still has increased levels of hemoglobin F and will be asymptomatic until his hemoglobin F is replaced by hemoglobin S
What is sickle cell anemia vs trait?
Anemia = Hb SS Trait = Hb AS
Presentation of sickle cell disease
9-18 months Painful dactylitis (swelling of bones of digits) Sudden severe infections Features of an acute crisis Chronic anemia
Management of sickle cell
Immunisations
Abx prophylaxis
Pain relief for crisis
